HomeMy WebLinkAboutBLDP-23-000094 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
u i o. CITY YARMOUTH MA DATE 7/7/22 PERMIT# BLDP-23-000094
JOBSII"E ADDRESS 658 ROUTE 28 OWNER'S NAME PHOENIX II LTD PARTNERSHIP
P OWNER ADDRESS C/O SHEPHERD AND GOLDSTEIN 316 MAIN ST WORCESTER,MA 01608-1553 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑
PRINT
CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑
FIXTURES FLOORS ,BSM, 1 . 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM 1
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTE
DISHWASHER 1
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN 2
INTERCEPTOR(INTERIOR)
KITCHEN SINK _ 1
LAVATORY 2 1
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK 1
TOILET 3
URINAL
WASHING MACHINE CONNECTION
WATER HEATER 1
WATER PIPING 1
OTHER 2
OTHER DESCRIPTION: hand wash sink
food prep sink
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY❑ BOND❑
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General
Laws,and that my signature on this permit application waives this requirement.
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision
of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Benjamin Diamantopoulos LICENSE#6496 SIGNATURE
MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# Lc ❑#
COMPANY NAME BENJAMIN DIAMANTOPOULOS ADDRESS 25 ANTHONY RD 25 ANTHONY RD
CITY W YARMOUTH STATE MA ZIP 026733776 TEL
FAX CELL EMAIL bendiamantopoulos@gmail.com
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE ❑
FEES S PERMIT It
PLAN REVIEW NOTES
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V .CHUSETTS UNIFORM APPLICATION FOR PE IT TO PERFORM PLUMBING WORK
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I 1-1=; ` � '22 MA DATE PERMIT# ?-3 - OCR
JOBSITE AID SS lo__ _____g_ f 7 OWNER'S NAME Ind C j 4 ,
t � ING DEPARTMENT
_uvF3 OWN !!:;SS TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL[S---- EDUCATIONAL ❑ RESIDENTIAL❑
PRINT
CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 10❑
FIXTURES-1 FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM :/
111
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM 110M�_-_-_�--_-_-
DEDICATED GRAY WATER SYSTEM NIII--
DEDICATED WATER RECYCLE SYSTEM ■n� IIII
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DISHWASHERI.
DRINKING FOUNTAIN ❑III■❑❑11111❑■SMI■■=
FOOD DISPOSER
FLOOR/AREA DRAIN _VA'_------__--_
INTERCEPTOR(INTERIOR)
KITCHEN SINK 3 Ap
LAVATORY iii
ROOF DRAIN
SHOWER STALL
i SERVICE I MOP SINK
TOILET _1E4_ ,=�.______
URINAL ■N■ ■■■E�■■■��■
1 WASHING MACHINE CONNECTION
i WATER HEATER ALL TYPES _BIZ i-___-___-___
WATER PIPING _BM_____________
OTHER _MI�������____�_
t ff t? 57AJ
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES E. NO ❑
IF YOU CHECKED YES, PLEASE INDICATE THE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY ❑ BOND ❑
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
t Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER ❑ AGENT ❑
SIGNATURE OF OWNER OR AGENT
I I hereby certify that all of the details and information I have submitted or entered regarding this application are true and ccurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliant h all Pertinent provision of the
Massachusetts State Plum " g Code and Chapter 142 of the General Laws.
PLUMBER' NAME , -/ �� LICENSE# /51/9 SIGNATURE
MP �JP CORPORATION[]# PARTNERSHIP❑.# LLC #
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COMPANY NAME a gi-r P t--/ ADDRESS Z5 AO T dOU
CITY YJt42Lhtt/ STATE VI-ZIP 0 .73 TEL-))O✓ 9 O 39 l
FAX CELL EMAILheil4/CP/14A Ti •Vc)v/Os CrIVil I
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES
1